Groups pushing for shift toward home health care

Marc Kovac/Capital Bureau Published: February 6, 2007 8:03AM

COLUMBUS -- Shifting Medicaid funding to home health-care providers from nursing homes and comparable facilities could save the state hundreds of millions of dollars annually, according to a study unveiled by an advocacy group Monday.

The Ohio Council for Home Care released the findings of "An Economic Study of Long-Term Care Costs in Ohio" during a press conference at the Statehouse. It commissioned the Columbus firm of Levin, Driscoll & Fleeter (at a cost of $25,000) to assemble and analyze Medicaid and health-related data; the information will be provided to the governor's office and lawmakers in advance of coming budget deliberations.

"The study has confirmed what we have long understood -- that Ohioans on Medicaid who wish to remain in their homes should be provided with that opportunity," said Kathleen Anderson, the council's executive director.

According to the study, home health services in Ohio cost a fraction of nursing home care ($11,800 per resident, compared to $56,000), said Howard Fleeter, who presented the findings.

Yet total Medicaid spending for nursing home care topped $2.6 million in 2003, compared to $881,421 spent for home health services, according to the study.

Overall, Ohio ranks 49th nationally in terms of the percentage of Medicaid spending devoted to home care (only 21 percent compared to 36 percent on average nationally), Fleeter said.

"It's a little shocking," William Kahl, visiting nurse and hospice director at Robinson Memorial Hospital in Ravenna, said of the results. (Kahl serves on the Ohio Council for Home Care board and attended Monday's press conference; Robinson Memorial provides home services to about 1,300 patients each year, plus another 350 involved in hospice, he said.)

By 2030, the number of residents age 65 and older will reach nearly 2.4 million, compared to 1.5 million counted during the 2000 U.S. Census, according to the study.

An additional 45,000 Ohioans will require long-term care in the next 25 years, Fleeter said. Increasing the percentage of those patients using home care to 36 percent from the present 21 percent would save the state close to $200 million, according to the study.

The study recommends waivers to provide Medicaid support for home health care, plus increases in reimbursement rates for the services. The rates have not been increased since 1998, Fleeter said.

The study acknowledged the role of nursing homes -- "the nursing home infrastructure provides an essential leg of support for Ohio's long-term care system. The state cannot afford to weaken the nursing home leg or put more pressure on it."

And nursing home advocates don't necessarily disagree about boosting home health care options.

"I think we could agree that Ohio needs to spend more money on home care," said Peter Van Runkle, president of the Ohio Health Care Association, which represents nursing home, assisted-living and other long-term care facilities.

But he added, "Everyone in Ohio should have choices for their long-term care. ... We also have to make sure that we provide enough funding to take care of all the people who still are going to need to be in nursing homes."